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Bladder and kidney cancer

Bladder and kidney cancer are two of the most common UK cancers (tenth and seventh, respectively). They present with symptoms that are typically investigated via the same diagnostic pathway. However, diagnosing these cancers can be challenging, especially as many of the symptoms are non-specific and occur commonly in patients without cancer. The quality of the diagnostic process can be affected by different factors – see our published systematic review.

In this workstream, we looked at the pre-diagnostic patterns of clinical features and test used in patients with bladder cancer, using linked national data from primary care, the Cancer Registry and secondary care. Our published papers include:

• Zhou Y, Abel GA, Hamilton W, Singh H, Walter FM, Lyratzopoulos G. Imaging activity possibly signalling missed diagnostic opportunities in bladder and kidney cancer: A longitudinal data-linkage study using primary care electronic health records. Cancer Epidemiology. 2020. doi:10.1016/j.canep.2020.101703
• Zhou Y, Walter FM, Singh H, Hamilton W, Abel GA, Lyratzopoulos G. Prolonged diagnostic intervals as marker of missed diagnostic opportunities in bladder and kidney cancer patients with alarm features: a longitudinal linked data study. Cancers. 2021. doi:10.3390/cancers13010156

For more information please contact: Yin Zhou

The USP Study

This is a prospective cohort study using a mixed-methods approach involving 1) primary care case note review and 2) nested interviews with patients and GPs. It aims to explore what happens during diagnostic journeys of patients with urological symptoms and how, why and when we can optimise the testing process in these patients in order to reduce missed diagnostic opportunities.

The study’s objectives are:

• To determine how and when English general practitioners investigate patients with urological symptoms
• To explore the patient, clinician and system factors that affect the timely use, performance and follow-up tests and results in patients with bladder and kidney conditions, including cancer

For more information please contact: Yin Zhou

Diagnostic performance of biomarkers for bladder cancer suitable for primary care: a systematic review 

Bladder cancer is the 11th most common cancer in the United Kingdom. If found early, the cancer is more likely to be treatable. Blood in urine is the only easily identifiable symptom, but blood is not always visible which makes cancer detection more difficult.

Most bladder cancers are diagnosed after a general practitioner (GP) refers for more examinations. There is no available screening programme for patients with a higher risk of developing bladder cancer. Evidence shows that more needs to be done to reduce missed opportunities for diagnosing bladder cancer in patients who first present with symptoms and are later diagnosed with cancer.

There is a lot of research being done on biomarkers (substances that can be found in urine or blood for example and can be used to tell apart those with and without cancer). Most of this research, however, is being done in specialist care settings where people have already been referred for suspected cancer. We need to identify more evidence that can be translated to the general population who consult in primary care before being diagnosed.

We aim to review the available evidence to find biomarkers that have been used to diagnose bladder cancer, and also report on those that have the potential to be used in primary care to help with the early detection of these cancers.

For more information please contact: Evie Papavasiliou or Valerie Sills